Workers Compensation Claims Examiner (California)

About the role

Sedgwick is hiring a Workers Compensation Claims Examiner to adjudicate complex California workers' compensation claims. The role covers high-exposure claims involving litigation and rehabilitation, ensuring claims are resolved within service expectations and client requirements, and includes identifying subrogation and negotiating settlements. The position is listed as remote.

Key responsibilities

• Analyze and process complex or technically difficult claims by investigating and gathering information to determine exposure.
• Negotiate settlement of claims within designated authority.
• Calculate and assign timely and appropriate reserves, and manage reserve adequacy throughout the life of the claim.
• Calculate and pay benefits due, approve and make timely payments and adjustments, and settle claims within authority level.
• Prepare necessary state filings within statutory limits.
• Manage the litigation process and report claims to the excess carrier, responding to requests for direction in a professional and timely manner.

Required profile

• Bachelor's degree from an accredited college or university preferred; professional certification for the line of business preferred.
• Four years of California workers' compensation claims management experience, or an equivalent combination of education and experience.
• Knowledge of California jurisdictional requirements; a SIP is required or must be obtained within one year of hire.
• Experience handling litigated and high-exposure claims, and managing claims through investigation, benefit determination, settlement negotiation and resolution.

Required skills

• Computer keyboarding.
• Ability to handle work-related stress, multiple priorities and deadlines, with clear conceptual thinking, judgment and discretion.

What we offer

• Starting pay range of $85,000 - $110,000 for this role.
• Flexible work schedule and referral incentive program.
• Career development and promotional growth opportunities.
• Medical, dental, vision, 401K on day one, PTO, disability and life insurance, and other benefits.